3.0 Health system performance

3.2 Accessibility

3.2.3 Pap smears, women aged 18-69

Definition: Women aged 18 to 69 who reported when they had their last Pap test.

Source: Statistics Canada, National Population Health Survey, 1994/95, 1996/97 and 1998/99, cross sectional sample, health file

3.3 Appropriateness

3.3.1 Vaginal birth after Caesarean section

Definition: Proportion of women who have previously received a Caesarean section, who give birth via vaginal delivery in an acute care hospital.

(ICD-9 or ICD-9-CM diagnosis code of 654.2).

There is considerable evidence that vaginal birth is safe for many women who have previously delivered by caesarean section. Women presenting with a history of a previous transverse low segment caesarean section, a single fetus in vertex presentation and no contraindications to a trial of labour should be offered the opportunity of vaginal delivery. (Clinical Practice Guidelines. Vaginal birth after previous caesarean birth. Society of Obstetrics and Gynecologists of Canada, 1997).

Source: Canadian Institute for Health Information, Hospital Morbidity Database

3.3.3 Caesarean sections

Definition: Proportion of women delivering babies in hospital by caesarean section. Due to characteristics of the database, stillbirths are excluded from the denominator.

(CCP procedure code of 86.0-86.2, 86.8, or 86.9; ICD-9-CM procedure code of 74.0-74.2, 74.4 or 74.99).

Source: Canadian Institute for Health Information, Hospital Morbidity Database

3.6 Effectiveness

3.6.6 Pneumonia and influenza hospitalization rate

Definition: Age-standardized acute care hospitalization rate for pneumonia and influenza, per 100,000 population age 65 and over.

(Primary ICD-9 or ICD-9-CM diagnosis code of 480-487).

This indicator reflects the burden of illness due to pneumonia and influenza, a portion of which may be preventable through influenza and pneumococcal immunization programs. High rates of preventable pneumonia and influenza may suggest a problem with access to immunization.

Source: Canadian Institute for Health Information, Hospital Morbidity Database

3.6.8 Ambulatory care sensitive conditions

Definition: Age-standardized inpatient acute care hospitalization rate for conditions where appropriate ambulatory care prevents or reduces the need for admission to hospital.

(Based on a list developed by Alberta Health - primary ICD-9 or ICD-9-CM diagnosis code of 250, 291-292, 300, 303-305, 311, 401-405, or 493).

While not all admissions for ambulatory care sensitive conditions are avoidable, it is assumed that appropriate prior ambulatory care could prevent the onset of this type of illness or condition, control an acute episodic illness or condition, or manage a chronic disease or condition. The "right" level of utilization is not known although a disproportionately high rate is presumed to reflect problems in obtaining access to primary care.

Source: Canadian Institute for Health Information, Hospital Morbidity Database

3.7 Efficiency

3.7.2 May not require hospitalization

Definition: Percentage of patients hospitalized in acute care facilities for conditions or procedures that often allow ambulatory treatment not requiring admission. These hospitalizations are classified as May Not Require Hospitalization (MNRH) and are derived from the case mix group methodology.

(May not require hospitalization CMGs: Lens insertion (055), other Ophthalmic procedures (057), other Ophthalmic procedures (063), Ethmoidectomy (088), Dental extraction/restoration (089), External & Middle ear procedures (090), Nasal procedures (091), Myringotomy (092), Tonsillectomy and Adenoidectomy procedures (093), Sinusitis (113), Sore throat (114), Miscellaneous ENT diagnosis (115), Croup (116), Atherosclerosis (229), Acquired valvilar disorders (232), Hypertension (233), Congenital cardiac disorders (234), Anus & Stomal procedures (266), Unilateral hernia procedures (271), Soft tissue procedures (378), Other Musculoskletal procedures (379),Other Lower extremity procedures (380), Hand & wrist procedures (381), Arthroscopy (382), Back Pain (409), Soign Symptoms & deformities (411), Joint Derangement (413), Sprains, Strains & minor injuries (414), Other Transurethral or biopsy procedures (512), Miscellaneous urinary tract procedures (514), Miscellaneous Urological diagnosis (534), Hematuria (535), Urinary Obstruction (536), Admission for dialysis (538), Miscellaneous male reproductive system procedures (554), Circumcision (555), Miscellaneous male reproductive system diagnosis (563), Gynecological Laproscopy (585), Tubal Interruption (586), Miscellaneous Gynecological procedures (587), Miscellaneous Gynecological procedures (596), False labour LOS <3 days (619), Anxiety disorders (791), Adjustment disorders (792), Personality disorder with Axis III diagnosis (793), Personality disorder without Axis III diagnosis (794), Sexual dysfunction & Sexual disorders (795), Specific development disorders (796), Miscellaneous Psychiatric diagnosis (797), Procedure cancelled (852), Vein ligation & stripping (893), Unrelated O.R procedure (906), Obsolete psychiatric diagnosis (909)).

MNRH analyses may prompt review of inpatient cases to identify opportunities for providing such care in ambulatory settings Case mix groups associated with MNRH do not suggest that a patient must be treated as ambulatory, as these patients may have a justifiable basis for inpatient admission.

Source: Canadian Institute for Health Information, Discharge Abstract Database

3.7.3 Percent alternate level of care days

Definition: Percentage of inpatient days where a physician (or designated other) has indicated that a patient occupying an acute care hospital bed was well enough to have been cared for elsewhere.

This indicator is designed to assess the processes that ensure the placement of patients in the most appropriate care setting. It identifies the proportion of patients who are occupying acute care beds due to the unavailability of services in another more appropriate setting.

Source: Canadian Institute for Health Information, Discharge Abstract Database

3.7.4 Expected compared to actual stay

Definition: The average number of actual days in acute care hospitals compared to expected length of stay.

Expected length of stay (ELOS) is calculated on typical patients taking into account the reason for hospitalization, age, comorbidity, and complications. Typical cases exclude deaths, transfers, voluntary sign-outs, and cases where the actual length of stay is greater than the "trim point" established by Canadian Institute for Health Information. The calculation uses the Case Mix Group (CMG) methodology and calibration for the given year (i.e., 1998/99 data uses CMG 1999 methodology). A positive ratio indicates actual days stay was longer than expected while a negative value suggests the average actual stay was shorter than expected.

Source: Canadian Institute for Health Information, Discharge Abstract Database

3.8 Safety

3.8.1 Hip fracture hospitalization

Definition: Age-standardized acute care hospitalization rate for fracture of the hip, per 100,000 population age 65 and over.

(Primary ICD-9 or ICD-9-CM diagnosis code of 820.0-820.3, 820.8, 820.9).

Hip fractures occur for various reasons including environmental hazards, the prescription of potentially inappropriate psychotropic medications to the ambulatory elderly, and safety issues in long-term care facilities. As well as causing disability or death, hip fractures can have a major impact on independence and quality of life. This measure is based on the number of cases admitted to hospital, not the number of unique individuals. Some cases may represent readmissions for additional treatments or transfers from one medical setting to another. Thus, the hospitalization rate may over-estimate the incidence of hip fractures.

Source: Canadian Institute for Health Information, Hospital Morbidity Database